J Pathol Transl Med.  2019 Jan;53(1):50-56. 10.4132/jptm.2018.11.30.

Quilty Lesions in the Endomyocardial Biopsies after Heart Transplantation

  • 1Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jsunkim@skku.edu
  • 2Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Health Sciences and Technology, Sungkyunkwan University, SAIHST, Seoul, Korea.


The aim of this study was to investigate the clinical significance of Quilty lesions in endomyocardial biopsies (EMBs) of cardiac transplantation patients.
A total of 1190 EMBs from 117 cardiac transplantation patients were evaluated histologically for Quilty lesions, acute cellular rejection, and antibody-mediated rejection. Cardiac allograft vasculopathy was diagnosed by computed tomography coronary angiography. Clinical information, including the patients' survival was retrieved by a review of medical records.
Eighty-eight patients (75.2%) were diagnosed with Quilty lesions, which were significantly associated with acute cellular rejection, but not with acute cellular rejection ≥ 2R or antibody-mediated rejection. In patient sdiagnosed with both Quilty lesions and acute cellular rejection, the time-to-onset of Quilty lesions from transplantation was longer than that of acute cellular rejections. We found a significant association between Quilty lesions and cardiac allograft vasculopathy. No significant relationship was found between Quilty lesions and the patients' survival.
Quilty lesion may be an indicator of previous acute cellular rejection rather than a predictor for future acute cellular rejection.


Quilty lesion; Endocardial inflammatory infiltrates; Acute cellular rejection; Cardiac allograft vasculopathy; Heart transplantation
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